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General assembly

Panel approves stricter rules in midwife bill

– The Senate Health Committee on Wednesday accepted an amendment to a bill meant to help increase the ranks of legal midwives in Indiana, though some supporters felt the new provision is too stringent.

House Bill 1135 then passed 11-1, moving to the full Senate for consideration.

The amendment offered by Sen. Patricia Miller, R-Indianapolis, generally stiffened regulations in the bill. She said she didn’t want to just legalize current practice but instead come up with a strong, long-term public policy on home birthing.

“We need the best standards possible for safe deliveries of the child and mother,” she said. “I’m trying to look beyond the immediate situation and come up with a strong standard for Indiana.”

It is currently a felony to practice midwifery – helping mothers give birth, often at home – without a license in Indiana.

And Indiana only licenses certified nurse midwives, which are registered nurses who have graduated from a nationally accredited school of midwifery; passed the National Certifying Examination given by the American College of Nurse-Midwives; and are licensed by the state nursing board to practice as a nurse midwife.

According to data from the Indiana State Department of Health, there were 1,058 intended live births at home in 2010. Of those, 357 were handled by nursemidwives.

Supporters of a wider midwifery law contend that the current ranks of nurse midwives are not meeting the needs, especially in rural areas – including serving the Amish.

As it passed the House, the legislation would create a midwifery board and set training and education requirements for certified professional midwives. That is a nationwide certification recognized in dozens of other states.

Miller’s amendment makes some key changes.

First, it establishes a new designation of certified direct entry midwife, rather than using the nationwide program. And the committee increased educational requirements to include an associate degree in nursing or other science field; or a bachelor’s degree in any field.

A certified direct entry midwife also must work with a supervising physician, who would see the expectant mother at least twice and review charts.

The midwife must have a collaborative agreement similar to what physician assistants have in Indiana. Also, the doctor would have to directly supervise 20 births with the midwife before he or she could act alone.

The doctor would be immune from liability, and the amendment requires midwives to maintain sufficient insurance coverage.

Kathy Williams, representing certified professional midwives in the state, argued that such insurance doesn’t exist. But Miller said that’s because most midwifery is illegal in Indiana currently.

Williams also said it has been difficult in other states to find physicians willing to collaborate with and supervise midwives.

Sen. Mark Stoops, D-Bloomington, was concerned that some women with decades of midwife experience wouldn’t qualify for licensing because of the education requirements.

“Will they suddenly find in January they aren’t legally allowed to do this?” he asked.

Miller reminded him they aren’t legally allowed to do it now. They are essentially practicing medicine without a license, and the purpose behind the bill is to legalize and professionalize the system.

Stoops also was concerned about the availability of physicians in rural areas to work with the midwives.

The bill would give the job of licensing certified direct entry midwives to the Indiana Medical Licensing Board. That panel would adopt rules and standards with feedback from a midwifery committee.

The new midwives also would have to undergo criminal background checks. And more data on complications from home births would be collected from birth certificates.